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Sponsors and Collaborators: |
Institute of Tropical Medicine, Belgium Belgian Government Tropical Diseases Research Centre, ZAMBIA |
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Information provided by: | Institute of Tropical Medicine, Belgium |
ClinicalTrials.gov Identifier: | NCT00711906 |
Malaria is a major contributor of disease burden in Sub-Saharan Africa, and pregnant women and children are the most vulnerable population. Malaria in pregnancy increases the risks of abortion, prematurity, maternal anaemia, low birth weight (LBW), perinatal, neonatal and infant mortality. For prevention and control of malaria in pregnancy, Intermittent Preventive Treatment (IPT), insecticide treated nets (ITNs) and case management for malaria and anemia are recommended. HIV infection in pregnancy increases the risk of malaria, LBW, post-natal mortality and also of anaemia. In pregnant women, HIV infection decreases the efficacy of IPT with the medicine sulfadoxine-pyrimethamine (SP), which is the only treatment with proven efficacy and safety in IPT and is recommended by the World Health Organization (WHO). Unfortunately, there is a documented increase of resistance to SP, so cotrimoxazole (CTX) could be an alternative: many studies in Zambia and Uganda demonstrated that it reduces mortality and morbidity in HIV infected persons, and CTX prophylaxis significantly improves birth outcomes in immuno-suppressed HIV women. Unfortunately, there is not yet information on its effectiveness for preventing placental malaria infection, maternal anaemia and LBW. Thus in this study, we aim to establish the safety and efficacy of daily CTX in preventing malaria infection during pregnancy and its consequences, both in HIV infected and non-infected pregnant women. This information is urgently needed to assist to issue guidelines on IPT in pregnancy.
Condition | Intervention | Phase |
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Malaria in Pregnancy, With or Without HIV Infection |
Drug: Cotrimoxazole Drug: Sulfadoxine-pyrimethamine |
Phase III |
Study Type: | Interventional |
Study Design: | Prevention, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | The Role of Daily Co-Trimoxazole Prophylaxis For Prevention of Malaria And Its Effects in Pregnancy |
Estimated Enrollment: | 2096 |
Study Start Date: | February 2009 |
Estimated Study Completion Date: | April 2011 |
Estimated Primary Completion Date: | December 2010 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
HIV-negative women taking CTX as chemoprophylaxis
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Drug: Cotrimoxazole
Cotrimoxazole
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2: Active Comparator
HIV-negative women taking SP as IPT
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Drug: Sulfadoxine-pyrimethamine
Sulfadoxine-pyrimethamine
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3: Experimental
HIV-positive women (CD4> 200) taking CTX as chemoprophylaxis
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Drug: Cotrimoxazole
Cotrimoxazole
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4: Active Comparator
HIV-positive women (CD4 > 200) taking SP as IPT
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Drug: Sulfadoxine-pyrimethamine
Sulfadoxine-pyrimethamine
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Malaria is a major contributor of disease burden in Sub-Saharan Africa, with pregnant women and children being the most vulnerable population. P.
falciparum infection in pregnancy leads to parasite sequestration in placental vascular space, with increased risks of abortion, stillbirth, prematurity, intrauterine growth retardation, maternal anaemia, low birth weight (LBW), perinatal, neonatal and infant mortality. In low transmission areas, malaria can evolve towards severe disease with high risk of mortality. In endemic areas, it is still associated with maternal anaemia, LBW and stillbirth. For prevention and control of malaria in pregnancy, WHO recommends Intermittent Preventive Treatment (IPT), insecticide treated nets (ITNs) and case management for malaria and anemia. HIV in pregnancy increases the risk of malaria, LBW, post-natal mortality and also anaemia, suggesting a synergistic interaction between HIV and malaria. In pregnant women, HIV-1 infection decreases the efficacy of sulfadoxine-pyrimethamine(SP)IPT, although 2 or more doses in 2nd and 3rd trimesters still reduce peripheral parasitaemia, placental infections and maternal anaemia. To date, SP is the only treatment with data on efficacy and safety in IPT: WHO recommends at least 2 doses after the first trimester. But there is a documented increase in SP resistance, so cotrimoxazole (CTX) could be an alternative: many studies in Zambia and Uganda demonstrated that it reduces mortality and morbidity in HIV infected individuals, and CTX prophylaxis significantly improves birth outcomes in women with CD4 count <200.
Concurrent administration of SP and CTX has been associated with increased incidence of severe adverse reactions in HIV-infected patient.
WHO has promoted CTX as alternative to SP for IPT in immuno-compromised HIV-infected pregnant women. Unfortunately, there is no information on effectiveness of daily CTX for preventing placental malaria infection, maternal anaemia and LBW. In the past, CTX has been used to treat malaria in children and daily use of CTX by non-pregnant HIV-infected adults has been associated with a 70% reductions of the incidence of clinical malaria.
In this study, we will target both HIV infected and non-infected pregnant women with CD4≥ 200/µL, with the aim to establish the safety and efficacy of daily CTX in preventing malaria infection during pregnancy and its consequences, by assuming that CTX is not inferior to SP in reducing placental parasitaemia: such information is urgently needed to assist to issue guidelines on IPT in pregnant women.
Genders Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Contact: Christine Manyando, MD | 260 212 621732 | manyando@zamnet.zm |
Contact: Eric Njunju, Bsc Msc | 260 212 621112 | enjunju@yahoo.com |
Zambia | |
Shampande Clinic | Recruiting |
Shampande, Zambia | |
Principal Investigator: Rhoda Mkandawire, MD MPH | |
Choma hospital | Recruiting |
Choma, Zambia | |
Principal Investigator: Rhoda Mkandawire, MD MPH |
Principal Investigator: | Christine Manyando, MD | Tropical Diseases Research Centre |
Study Director: | Jean-Pierre Van geertruyden, MD PhD | Institute of Tropical Medicine |
Responsible Party: | Institute of Tropical Medicine ( Prof. Umberto D'Alessandro, MD PhD ) |
Study ID Numbers: | ITMP0108 |
Study First Received: | July 8, 2008 |
Last Updated: | April 20, 2009 |
ClinicalTrials.gov Identifier: | NCT00711906 History of Changes |
Health Authority: | Zambia: Pharmaceutical Regulatory Authority |
Malaria Pregnancy HIV |
Intermittent Preventive Treatment Safety Efficacy |
Pyrimethamine Protozoan Infections Trimethoprim Sexually Transmitted Diseases, Viral Sulfadoxine-pyrimethamine Sulfamethoxazole Acquired Immunodeficiency Syndrome Anti-Infective Agents, Urinary Trimethoprim-Sulfamethoxazole Combination Malaria |
Folic Acid Antagonists Sulfadoxine Immunologic Deficiency Syndromes Folic Acid Virus Diseases Antimalarials HIV Infections Sexually Transmitted Diseases Parasitic Diseases Retroviridae Infections |
Pyrimethamine Anti-Infective Agents Sexually Transmitted Diseases, Viral Antiprotozoal Agents Slow Virus Diseases Molecular Mechanisms of Pharmacological Action Malaria Trimethoprim-Sulfamethoxazole Combination Renal Agents Infection Antimalarials Antiparasitic Agents Therapeutic Uses Parasitic Diseases Retroviridae Infections |
Protozoan Infections RNA Virus Infections Sulfadoxine-pyrimethamine Immune System Diseases Coccidiosis Acquired Immunodeficiency Syndrome Anti-Infective Agents, Urinary Enzyme Inhibitors Folic Acid Antagonists Sulfadoxine Pharmacologic Actions Immunologic Deficiency Syndromes Virus Diseases HIV Infections Sexually Transmitted Diseases |